3
Topographical and Pathotopographical Anatomy of the Chest

The chapter on the ultrasonic topography and pathotopographic anatomy of the chest includes the layer-by-layer topography of surface structures (skin, subcutaneous fat, surface and deep muscles of the chest, ribs, ligaments), surface organs (mammary glands, lymph nodes), and deeply situated organs (heart, vessels, including ascending and descending aorta, aortic arch, lungs, and pleura).

Ultrasonic images of the skin, subcutaneous fat, surface and deep muscles, vessels of subcutaneous layer, and thoracic aorta are presented. Images of the base, apex, and chambers of the heart have been verified based on comparison with the topographic anatomy data.

Echocardiography (EchoCG) is the method of cardiac research based on the use of reflected ultrasonic waves.

The history of EchoCG dates back more than 40 years to the works of I. Edler and C. Hertz, who for the first time used ultrasonic pulse reflection in cardiac studies.

Modern echocardiography is a complex method providing a broad range of diagnostic procedures. Modern cardiographic techniques use 2-D, 1-D, and Doppler EchoCG, which allow volume of the heart chambers to be measured, morphology and functions of both natural and artificial valves to be studied, the contractile activity of the myo-cardium to be estimated, and the location and volume of intracardiac shunts and the presence of intracardiac structures to be determined.

2-D EchoCG (B-mode) is the method for obtaining 2-D images of the heart (cross-sections) with respect to the long and short axes in real-time mode. 2-D EchoCG provides:

• assessment of the size and volume of the heart chambers, thickness of the heart walls, weight of the left ventricular myocardium;
• assessment of global and local ventricular contractility;
• calculation of the liquid volume in pericardium;
• detection of developmental anomalies and acquired pathologies of the valve apparatus and subvalvular structures;
• detection of atrial and ventricular septal defects, their number and location;
• detection of outlet anomalies of the heart;
• detection of cardiac tumors and intracardiac blood clots.

Introduction of EchoCG in clinical practice increased the quality of diagnosis of congenital and acquired heart diseases. EchoCG became indispensable for cardiac surgery because of its high information content and simple use, which made it possible to avoid more sophisticated invasive diagnosis.

1-D EchoCG (M-mode) is a technique for the imaging of heart wall and valve motion in time. 1-D EchoCG provides information about mobility of heart structures intercepted by a single ultrasonic beam. Presently, 1-D EchoCG is used as an accessory mode of echocardiography, primarily for measurements.

The problem of correlation of the thyroid and mammary gland pathologies is of interest to endocrinologists, reproductive endocrinologists, and mammologists, as well as ultrasound diagnosticians.

It is well known that the pituitary-thyroid system and pituitarygonadal system are controlled by the hypothalamus, which determines to a large extent the functional correlation between the systems. The neurons of the mediobasal region of the hypothalamus synthesize a gonadotropin-releasing hormone and release it into the hypophyseal portal system. The neurons of the preoptic region of the hypothalamus synthesize a thyrotropin-releasing hormone. In pituitary gland cells, the thyrotropin secretion is stimulated by a thyrotropin-releasing hormone. Dysfunction of the pituitary-thyroid system can modify secretion not only of gonadotropin, but of prolactin as well. Therefore, the hypothalamic thyrotropin-releasing hormone potentially stimulates the release not only of thyrotropin, but also of prolactin. Increase in T3 and T4 above the normal level inhibits prolactin, while the decrease of T3 and T4 in blood plasma enhances the prolactin release stimulated by the thyrotropin-releasing hormone, thereby leading to hyperprolactinemia.

Presently, breast ultrasound is the most available diagnostic procedure. It is noninvasive and inexpensive, has no contraindications, provides valuable diagnostic information, and exhibits no pharmacologic or radiation load on the human body.

The diagnostic importance of ultrasound has considerably increased due to improvements in high-frequency sensors and introduction of digital technologies.

Color Doppler Imaging (CDI) and Power Doppler Imaging (PDI) allow the hemodynamics to be diagnosed in cases both of normal results of breast ultrasound, and of diffuse changes and the presence of pathological foci.

Complex ultrasonic research was implemented using standard scanning modes:

• gray-scale (B-mode);
• color Doppler mapping of blood flow energy and rate;
• spectral Doppler imaging.

In some cases, 3-D reconstruction was used to provide better spatial presentation of anatomical interaction between the structures.

The presence of any of the symptoms listed below was considered as an indication for examination: palpated neoplasms in thyroid or mammary gland; any clinical form of mastopathy; any clinical form of thyroid dysfunction; plugged duct or mastitis in anamnesis; mammary gland injury; changes observed in mammogram; severe family medical history concerning mammary gland and thyroid.

Figure 41 Sagittal section of the chest and abdomen.

1. Liver; 2. Large intestine; 3. Small intestine loops; 4. Right atrium; 5. Left ventricle; 6. Breast bone; 7. Lung; 8. Long muscles of the back; 9. Spinal column.

Figure 42 Cross-section of the chest.

1. Arch of aorta; 2. Superior vena cava; 3. Trachea; 4. Esophagus; 5. Sympathetic trunk; 6. Right lung; 7. Left lung; 8. Vertebra; 9. Spinal cord; 10. Breast bone; 11. Mediastinal cellular tissue; 12. Pleura.

Figure 43 Topography of the mammary gland.

1. M. deltoideus; 2. M. trapezius; 3. M. sternocleidomastoideus; 4. N. lymphatici supraclaviculares; 5. Clavicula; 6. N. lymphatici subclaviculares; 7. M. pectoralis minor; 8. M. pectoralis major; 9. Tracti lymphatici ut nodi lumphatici sternalis; 10. Tracti lumphatici ut noda lymphatici epigastrici et subphrenici; 11. Tracti lymphatici ut nodi lymphatici axillares; 12. V. thoracica externa; 13. N. l. paramammaria; 14. N. lymphatici axillares; 15. M. latissimus dorsi; 16. V. axillaris.

Figure 44 Topography of the chest.

1. Cor; 2. Pulmo dextrum; 3. Pulmo sinistrum; 4. Arcus aortae; 5. a. carotis communis dextra; 6. a. carotis communis sinistra; 7. Bronchi; 8. Aorta thoracica.

Figure 45 Topography of the blood vessels and heart.

1. Cor; 2. v. cava inferior; 3. a. carotis communis dextra; 1 4. Trachea; 5. v. jugularis interna; 6. v. subclavia sinistra; 7. a. subclavia sinistra; 8. a. carotis communis sinistra; 9. aa. et vv. intercostales.

Figure 46 Topography of the blood vessels and heart.

1. Cor; 2. v. cava inferior; 3. a. carotis communis dextra; 4. Trachea; 5. v. jugularis interna; 6. v. subclavia sinistra; 7. a. subclavia sinistra; 8. a. carotis communis sinistra; 9. aa. et vv. intercostales.

Figure 47 Topography of the lung roots.

1. Truncus sympathcus; 2. aa. et nervi intercostales; 3. n. vagus; 4. a. pulmonalis; 5. n. splanchnicus major; 6. v. azygos; 7. Diaphragm; 8. Bronchi dexter; 9. Easophageus; 10. Trachea; 11. n. phrenicus; 12. vena cava superior; 13. vv. pulmonales; 14. Nodus lymphaticus.

1. n. splanchnicus major; 2. n. splanchnicus minor; 3. n. vagus; 4. n. phrenicus; 5. n. recurrens; 6. a. pulmonales; 7. Bronchi sinister; 8. vv. pulmonales; 9. Diaphragm; 10. Pericardium; 11. r. sympathies n. intercostales; 12. a. subclavia; 13. Arcus aortae; 14. v. hemiazygos; 15. Truncus sympathicus.

1. Easophageus; 2. Trachea; 3. a. carotis communis; 4. a. subclavia; 5. n. recurrens; 6. n. vagus; 7. v. hemiazygos; 8. Pulmo sinister; 9. Bronchi dexter; 10. Nodi lymphatici tracheobronchiales; 11. Bronchi sinister; 12. Pulmo dexter; 13. a. pulmonales sinister; 14. Arcus aortae.

Figure 48 Topography of the bifurcation of the trachea and the aorta.

1. Right recurrent nerve; 2. Vagus nerve; 3. Common carotid artery; 4. Clavicular artery; 5. Brachiocephalic trunk; 6. Arch of aorta; 7. Tracheal bifurcation; 8. Tracheobronchial lymph nodes; 9. Left recurrent nerve; 10. Left bronchus; 11. Right bronchus; 12. Esophagus.

Figure 49 Topography of the heart and the lungs.

1. Arterial cone; 2. Pulmonary trunk; 3. Left pulmonary artery; 4. Right pulmonary artery; 5. Trachea; 6. Right lung; 7. Left lung; 8. Ascending aorta; 9. Arch of aorta; 10. Brachiocephalic trunk; 11. Common carotid artery; 12. Clavicular artery; 13. Right atrium; 14. Right ventricle; 15. Left atrium; 16. Left ventricle.

Figure 50 Topography of the heart.

1. Arch of aorta; 2. Left pulmonary artery; 3. Superior vena cava; 4. Transition line of the pericardium; 5. Right pulmonary artery; 6. Right pulmonary veins; 7. Right atrium; 8. Inferior vena cava; 9. Right coronary artery; 10. Blood vessels of the right ventricle; 11. Middle cardiac vein and right descending coronary artery; 12. Left...